Durability of antidepressant response to repetitive transcranial magnetic stimulation: Systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical studies evaluating treatment durability
PubMed 30344109 · doi:10.1016/j.brs.2018.10.001
What was done
Systematic review and meta-analysis of 19 studies (published 2002–2018) assessing antidepressant outcomes 3 or more months following an induction course of repetitive transcranial magnetic stimulation (rTMS) for depression. Among initial responders, response rates were meta-analyzed at 3, 6, and 12 months after induction, and predictors of sustained response were analyzed using random-effects meta-regression.
What was found
Eighteen studies were analyzed at 3 months (732 patients) and 6 months (695 patients), and 9 studies at 12 months (247 patients). Among initial responders, sustained response rates were: - 3 months: 66.5% (95% CI = 57.1–74.8%, I² = 27.6%) - 6 months: 52.9% (95% CI = 40.3–65%, I² = 0%) - 12 months: 46.3% (95% CI = 32.6–60.7%, I² = 0%) Random-effects meta-regression identified a higher proportion of women and receipt of maintenance treatment as significant predictors of higher response rates at specific time-points.
Why it matters
Quantifies long-term outcomes following rTMS, showing that therapeutic benefits persist for up to a year in roughly half of initial responders and that maintenance protocols may protect against relapse.
Limits
Follow-up data at 12 months were available for only 9 studies and 247 patients. Outcomes are restricted strictly to patients who had already responded to acute induction. The abstract does not report details on concurrent medications or standardisation of maintenance protocols across studies.
Cited by
- contradicts Transcranial magnetic stimulation (TMS) outcomes for depression show high relapse rates and lack durability beyond 6 months.